血液灌流联合标准化洗胃方案在急诊误服有机磷农药抢救的应用及对预后的影响

Application of Hemoperfusion Combined with Standardized Gastric Lavage in Emergency Rescue of Mistaken Organophosphorus Pesticides and its Effect on Prognosis

目的探究血液灌流联合标准化洗胃方案在急诊误服有机磷农药抢救的应用及对预后的影响。方法选取江苏省东台市中医院2015年1月至2018年6月急诊误服有机磷农药患者共68例,将所有患者按照不同治疗方式分成研究组和对照组,每组各34例,研究组采用血液灌流联合标准化洗胃方案对患者进行治疗,对照组按标准洗胃方案,比较分析两组患者在入院时及入院各时间点(24、48和72 h)静脉血血常规[白细胞计数(WBC)、中性粒细胞数(NEUT)]及降钙素原(PCT)水平变化;比较两组患者乙酰胆碱酯酶(AchE)和淀粉酶(AMY)恢复正常的时间、阿托品人均用量以及重症监护病房(ICU)住院天数,首次洗胃时间、达到阿托品化时间及阿托品总用量、反跳发生率及不良反应发生率等指标。结果研究组与对照组患者入院各时间点WBC及NEUT比较差异均无统计学意义(P>0.05);研究组患者静脉血WBC指标在24 h、48 h和72 h时较对照组均有所降低,研究组患者NEUT值在48 h和72 h时低于对照组,差异有统计学意义(P<0.05),比较两组患者于入院时及入院各时间点降钙素原(PCT)水平变化,在48 h和72 h时研究组低于对照组,差异有统计学意义(P<0.05),在研究组患者治疗后乙酰胆碱酯酶(AchE)、淀粉酶(AMY)恢复至正常时间均低于对照组,差异有统计学意义(P<0.05),在研究组患者治疗后阿托品人均用量及达到阿托品化的时间均低于对照组,差异有统计学意义(P<0.05),在两组患者治疗指标的比较中我们发现两组患者在反跳发生率、机械通气时间及重症监护病房(ICU)住院时间方面,研究组均低于对照组,差异有统计学意义(P<0.05)。结论采用血液灌流联合标准化洗胃方案在急诊误服有机磷农药抢救中具有积极意义,能够有效提高患者生存率,对改善肝肾功能损害具有积极的意义,具有较高临床意义。

Objective To explore the application of blood perfusion combined with standardized gastric lavage in emergency rescue of mistaken organophosphorus pesticides and its impact on prognosis.Methods Select a total of 68 patients with organophosphorus pesticide in Dongtai Hospital of Traditional Chinese Medicine between January 2015 and June 2018.All the patients were divided into research group and the control group,the team using blood perfusion combined standardized treatment of patients with gastric lavage solution control group according to the standard of gastric lavage,comparative analysis of two groups of patients in hospital and the hospital each time point(24 h,48 h and 72 h)venous blood routine blood[white blood cell count(WBC),neutrophil counts(NEUT)]and calcitonin(PCT)level changes;The recovery time of AchE and AMY to normal,the per capita dosage of atropine,the number of days in intensive care unit(ICU),the time of first gastric lavage,the time to reach atropine,the total dosage of atropine,the incidence of rebound and adverse reactions and other indicators were compared between the two groups.Results There were no statistically significant differences in WBC and NEUT between study group and control group at each time point of admission(P>0.05).Team in patients with venous blood WBC indicators within 24 h,48 h and 72 h as a control group were reduced,the team NEUT value in 48 patients with h and 72 h is lower than the control group,the difference was statistically significant(P<0.05),and compare the two groups of patients in hospital and the hospital each time point calcitonin(PCT)level changes,at 48 h and 72 h group is lower than the control group,the difference was statistically significant(P<0.05),in the team after treatment in patients with acetylcholinesterase(AchE),amylase(AMY)back to normal time are lower than the control group,Difference was statistically significant(P<0.05),in the team after treatment in patients with atropine dosage per capita and achieve atropine time are lower than the control group,the difference was statistically significant(P<0.05),the index of two groups of patients we found in the comparison of the two groups of patients in the bounce rate,mechanical ventilation time and intensive care unit(ICU),length of hospital stay,the team were lower than the control group,the difference was statistically significant(P<0.05).Conclusion The application of hemoperfusion combined with standardized gastric lavage has positive significance in emergency rescue of accidental ingestion of organophosphorus pesticide,which can effectively improve the survival rate of patients,and has positive significance in improving the liver and kidney function damage,and has higher clinical significance.